Whose Knowledge of Disability Has Value?

Last week I chronicled the five-year process I had to go through to get medical documentation of my disability. I mentioned that I was dumbfounded that after going to my main eye doctor for a few years and finally throwing a fit, he mentioned that his practice had a low vision specialist that he could send me to.

I want to linger on this point today for a couple of reasons. First, it illustrates how much self-advocacy disabled folks often have to engage in just to get documentation of their disability. Second, it demonstrates how little many medical professionals know about the conditions disabled folks struggle with; and yet, the common requirement for a doctor’s documentation of a disability assumes that the person experiencing the disability has no knowledge of value about their disability. Only a medical professional’s knowledge of the disability has value.

Until the moment my doctor mentioned a low vision specialist, I didn’t know what “low vision” was or that there was such a thing as a “low vision specialist.” Despite not knowing the term low vision, I knew that I was having trouble driving, reading, navigating spaces, and more. I had chronicled on social media many of my mishaps. Everyone who interacted with me regularly knew I was struggling with some sort of debilitating vision issue. But none of that mattered in my pursuit of the documentation I needed to get accommodations at work.

I wondered for a long time why none of the eight doctors I was seeing to try to figure out what was wrong with my eyes had mentioned low vision or a low vision specialist to me sooner. I think part of the problem is that each doctor only notices what they specialize in, and I think another part of the problem is that “low vision specialists” treat people like me—the problematic patients, the cases that defy an obvious fix, the situations in which there might not be a neat and tidy diagnosis. Many disabled people have conditions like mine that are difficult to diagnose—fibromyalgia, for example, or lupus, or Lyme disease—and will need to see multiple doctors, many of whom will probably doubt their reports of what they are experiencing, to finally get the documentation that will have meaning at work or at school.

It turns out my husband is also one of those problematic patients. After his stroke, he was diagnosed with homonymous hemianopsia, which means he only sees the right half of the visual field out of each eye. The ophthalmologist who diagnosed it told us there was nothing that could be done. When I asked for a referral to the low vision specialist (my insurance only covers low vision specialists with a referral—and then charges a copay twice that of the usual copay), the ophthalmologist said, “Yes, but there’s nothing that can be done.”

Low vision specialists, unlike other eye doctors, focus on helping patients make the most of the vision they do have, which often involves “hack”-type strategies, such as, in my case, using a white cutting board for foods that are colorful and a colored cutting board for foods that are white. Because eye fatigue is a significant factor for me, my low vision specialist has worked a lot with me on strategies for reducing eye fatigue. One thing my low vision specialist has done that no other doctor did is to simply believe me when I told her I was having trouble seeing.

Our doctors doubt us. Our institutions doubt us. And then even with the documentation, our colleagues or professors or bosses doubt us. I am asked regularly at work if I really need the accommodations I have asked for.

I have a very simple suggestion for improving this situation in both academia and workplaces: consider the disabled person’s experience and expertise on their own situation to have value. Allow the disabled person to document their own experience. Consider the disabled person’s journal of their experience to be documentation. I was no less disabled before my diagnosis than after, and I could have easily provided documentation of my disability through journals and social media posts (my Facebook friends probably became very tired of me posting pictures of signs I couldn’t read because of lack of contrast), but my employer did not consider me disabled until a doctor said I was. My experience of having been disabled for five years had no value at all in my quest for accommodations.

We can do better.

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